Cardiology Department, Acibadem University, Istanbul, Turkey.
J Interv Cardiol. 2013 Apr;26(2):208-13. doi: 10.1111/joic.12000. Epub 2012 Nov 28.
Our aim was to establish the frequency of radial artery spasm (RAS) and its predictors at the beginning of a transradial approach (TRA).
This was a single-center prospective study. A total of 1,722 consecutive patients undergoing their first transradial coronary procedure were recruited. After radial artery puncture, a hydrophilic sheath was used to complete arterial puncture, then 500 μg glycerol trinitrate and 2.5 mg verapamil were injected into radial artery along the sheath. After retrograde radial arteriography spasm was defined angiographically as a stenosis greater than 25%. Patient demographics, procedural data such as total procedural duration, the number of catheters and guidewires used, the amount of contrast media usage, dose area product (DAP) and fluoroscopy time, and vascular complications were recorded.
The overall spasm incidence was 10.3%. The procedural success rate was lower in patients with spasm than in patients without spasm (80% vs. 95.7%, P < 0.001). The patients with spasm were older (mean age 63.9 ± 9.4 years vs. 60.0 ± 11.2 years, P < 0.001) and more commonly female (51.3% vs. 34.4%, P < 0.001). Spasm was more common in hypertensive patients (66% vs. 56%, P < 0.009). Surprisingly, smoking was less common in patients with spasm (17% vs. 29%, P < 0.001). Multiple logistic regression analysis showed that female gender (OR = 1,524, 95% CI: 1.033-2.248, P = 0.034) was the only independent predictor of RAS at the beginning of the procedure.
The incidence of RAS was 10,3%, and female gender was the sole independent predictor of RAS at the very beginning of the procedure in patients undergoing a TRA.
本研究旨在探讨经桡动脉入路（TRA）起始时桡动脉痉挛（RAS）的发生频率及其预测因素。
这是一项单中心前瞻性研究。共纳入 1722 例首次接受经桡动脉冠状动脉介入治疗的连续患者。桡动脉穿刺后，使用亲水鞘完成动脉穿刺，然后向鞘内注射 500μg 硝酸甘油和 2.5mg 维拉帕米。逆行桡动脉造影显示狭窄>25%时定义为痉挛。记录患者的人口统计学资料、手术相关数据（如总手术时间、使用的导管和导丝数量、造影剂使用量、剂量面积乘积（DAP）和透视时间）和血管并发症。
总的痉挛发生率为 10.3%。痉挛患者的手术成功率低于无痉挛患者（80% vs. 95.7%，P<0.001）。痉挛患者年龄较大（平均年龄 63.9±9.4 岁 vs. 60.0±11.2 岁，P<0.001），女性更常见（51.3% vs. 34.4%，P<0.001）。高血压患者的痉挛更常见（66% vs. 56%，P<0.009）。令人惊讶的是，痉挛患者的吸烟率较低（17% vs. 29%，P<0.001）。多因素逻辑回归分析显示，女性（OR=1.524，95%CI：1.033-2.248，P=0.034）是 TRA 起始时 RAS 的唯一独立预测因素。
在接受 TRA 的患者中，RAS 的发生率为 10.3%，女性是 TRA 起始时 RAS 的唯一独立预测因素。
